急诊青光眼患者流行病学特征分析

目的 研究急诊青光眼患者人口学特征、诊断分类、季节分布和治疗转归.设计前瞻性病例系列.研究对象2018年10月23日～2019年10月22日就诊于北京同仁医院眼科急诊的急性眼压升高的青光眼患者205例(230眼).方法 初诊时记录患者的病史、体征和诊治情况,急诊救治后由青光眼专家进一步明确诊断,完成后续治疗,随访1年以...

Epidemiological characteristics of acute glaucoma in emergency clinic

Objective To investigate the epidemiological characteristics and treatment outcome of acute glaucoma. Design Prospective case series. Participants 205 consecutive cases (230 eyes) of acute glaucoma visited in Beijing Tongren Hospital emergency room from October 23, 2018 to October 22, 2019. Methods The demographic information, initial and confirmed diagnosis, time of visit, treatment outcome were collected from the Hospital Information System (HIS) of Beijing Tongren Hospital and customized CRF. The rank sum test, the chi-square test and Fisher exact test were used for statistically analyze. Main Outcome Measures Demographic information, time of visit, diagnosis and disease proportion of all kinds of glaucoma, treatment and visual prognosis after follow up at least 1 year. Results In 205 cases (230 eyes), the majority of subjects were from Beijing (72.7%) and female (63.4%), and the mean age was 61.7±13.8 years（9～89）， 60~69 years old were the most（41.5%）. The mean presenting IOP was 46.4±11.8 mmHg. Acute primary angle-closure glaucoma (APACG, n=132, 64.4%) was the most common diagnosis，followed by secondary glaucoma (n=59, 28.8%). The diagnostic agreement between emergency ophthalmologist and glaucoma specialist was 88.8%, the main misdiagnosis came from secondary glaucoma due to subluxation of lens. With medical therapy, APACG attacks resolved within 2 hours in 85 cases (64.4%), but medical treatment was unable to break the initial acute attack of 18 cases (66.7%) secondary glaucoma due to lens subluxation. Winter had higher incidence of acute high IOP attack than other seasons (χ2=219.769, P<0.001). The proportion of blindness and low vision in the last follow-up were 12.2% (n=25) and 8.3% (n=17), respectively. Conclusion Emergency glaucoma patients are mainly primary angle-closure glaucoma. Midwinter and midsummer are high seasons. Glaucoma secondary to lens subluxation is easily misdiagnosed as APACG, and the effect of medication is not good enough. 20.5% of low vision or blindness after active treatment. (Ophthalmol CHN, 2021, 30: 441-446)